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Patient identification of diagnostic safety blindspots and participation in “good catches” through shared visit notes

Bell, Sigall K., Bourgeois, Fabienne, Dong, Joe, Gillespie, Alex ORCID: 0000-0002-0162-1269, Ngo, Long H., Reader, Tom W., Thomas, Eric J. and DesRoches, Catherine M. (2022) Patient identification of diagnostic safety blindspots and participation in “good catches” through shared visit notes. Milbank Quarterly. ISSN 0887-378X (In Press)

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Context: Policy shifts toward health information transparency provide a new opportunity for patients to contribute to diagnostic safety. We investigated whether sharing clinical notes with patients can support identification of “diagnostic safety blindspots” - potentially consequential breakdowns in the diagnostic process that may be difficult for clinical staff to observe. Method: We used mixed methods to analyze patient-reported ambulatory documentation errors among 22,889 patients who read >1 visit note(s) at 3 US healthcare centers. We identified blindspots using and tailoring a previously established taxonomy. We used multiple regression analysis to identify factors associated with blindspot identification. Findings: 774 patients reported a total of 962 blindspots in 4 categories: (1) diagnostic misalignments (n=421, 43.8%), including inaccurate symptoms or histories and failures or delay in diagnosis; (2) errors of omission (38.1%) including missed main concerns or next steps, and failure to listen to patients; (3) problems occurring outside visits (14.3%) such as tests, referrals, or appointment access; and (4) multiple low-level problems (3.7%) cascading into diagnostic breakdowns. Many patients acted on the blindspots they identified, resulting in “good catches” that may prevent potential negative consequences. Older, female, sicker, unemployed or disabled patients, or those who work in healthcare were more likely to identify a blindspot. Individuals reporting less formal education; those self-identifying as Black, Asian, other or multiple races; or participants who deferred decision-making to providers were less likely to report a blindspot. Conclusion: Patients who read notes have unique insight about potential errors in their medical records that could impact diagnostic reasoning, but may not be known by clinicians - underscoring a critical role for patients in diagnostic safety and organizational learning. From a policy standpoint, organizations should encourage patient review of visit notes, build systems to track patient-reported blindspots, and promote equity in note access and blindspot reporting

Item Type: Article
Official URL:
Additional Information: © 2022 Milbank Memorial Fund
Divisions: Psychological and Behavioural Science
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
B Philosophy. Psychology. Religion > BF Psychology
Date Deposited: 12 Sep 2022 11:27
Last Modified: 10 Nov 2022 17:15

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